eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Trauma

Human Bites: Differential Diagnoses & Workup

Author: Ian K McLeod, MD, Assistant Professor, Department of Surgery, Uniformed Services University of the Health Sciences; Chief, Otolaryngology Service, DeWitt Army Community Hospital
Coauthor(s): Daniel J Gallagher III, MD, Attending Surgeon, Department of Otolaryngology, Walter Reed and DeWitt Army Hospitals; Don R Revis Jr, MD, Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine; Michael Brent Seagle, MD, Associate Professor, Division of Plastic Surgery, University of Florida College of Medicine; Consulting Staff, Florida Surgical Center
Contributor Information and Disclosures

Updated: May 21, 2008

Workup

Laboratory Studies

  • Laboratory studies are required if bacteremia or sepsis is suspected.
  • Obtain appropriate baseline viral titers from the patient and the assailant (if applicable and available).

Imaging Studies

  • Radiographs may be useful in evaluating foreign bodies (eg, tooth fragments), air in a joint, or injuries occurring over bone to reveal fractures.
  • Radiographs of chronic wounds may reveal underlying osteomyelitis.

Other Tests

  • Routine culture of every human bite wound is unnecessary.
    • Cultures are costly, demonstrate no growth in more than 80% of cases, and rarely alter first-line therapy.
    • Furthermore, wounds that subsequently manifest signs of infection often have bacteriologic profiles that differ from those shown on initial cultures.
  • Cultures are indicated in wounds with signs of infection (eg, cellulitis, swelling, purulence) and in wounds showing no clinical improvement despite appropriate antimicrobial therapy.
    • Obtain aerobic and anaerobic cultures, and grow them for 7-10 days to identify slow-growing pathogens. This will allow for the quantification and identification of bacterial species and their antibiotic susceptibilities.
    • Obtain cultures before the start of antimicrobial therapy whenever possible.

More on Human Bites

Overview: Human Bites
Differential Diagnoses & Workup: Human Bites
Treatment & Medication: Human Bites
Follow-up: Human Bites
References
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References

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  4. Ball V, Younggren BN. Emergency management of difficult wounds: part I. Emerg Med Clin North Am. Feb 2007;25(1):101-21. [Medline].

  5. Bartholomew CF, Jones AM. Human bites: a rare risk factor for HIV transmission. AIDS. Feb 28 2006;20(4):631-2. [Medline].

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Further Reading

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Keywords

human bites, bite wounds, Eikenella corrodens, E corrodens, human bite wounds, occlusive bites, hepatitis B, bites, wound infection, clenched-fist injuries, bite infection, human saliva

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Contributor Information and Disclosures

Author

Ian K McLeod, MD, Assistant Professor, Department of Surgery, Uniformed Services University of the Health Sciences; Chief, Otolaryngology Service, DeWitt Army Community Hospital
Ian K McLeod, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel J Gallagher III, MD, Attending Surgeon, Department of Otolaryngology, Walter Reed and DeWitt Army Hospitals
Daniel J Gallagher III, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Medical Association
Disclosure: Nothing to disclose.

Don R Revis Jr, MD, Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine
Don R Revis Jr, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Michael Brent Seagle, MD, Associate Professor, Division of Plastic Surgery, University of Florida College of Medicine; Consulting Staff, Florida Surgical Center
Michael Brent Seagle, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Plastic and Reconstructive Surgery, and Southeastern Society of Plastic and Reconstructive Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Clark A Rosen, MD, Director, University of Pittsburgh Voice Center; Associate Professor, Department of Otolaryngology and Communication Science and Disorders, University of Pittsburgh School of Medicine
Clark A Rosen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David W Stepnick, MD, Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center
David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

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